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Early medication may delay joint replacement in patients with RA
Early treatment with methotrexate or other disease-modifying anti-rheumatic drugs may delay the need for joint replacement, according to the results of a retrospective study.
Researchers identified 11,365 patients with rheumatoid arthritis (RA) in the Quebec Health Insurance Program. Patients were diagnosed between Jan. 1, 2002 and Dec. 31, 2011 and had at least three visits with billing codes for RA and were followed for at least 3 years. Patients were excluded in the presence of a diagnosis with RA prior to 2002. All patients had prescription drug coverage under a public health program.
Prescription drug use and surgeries were identified in the cohort. About 10% of the patients filled at least one prescription for anti-tumor necrosis factor-alpha (anti-TNF-a) while 58% received methotrexate and 65% used another disease-modifying anti-rheumatic drug (DMARD).
Of the 11,365 patients with RA, 608 had knee (41.6%) or hip (28.2%) replacements, or 1.09 joint replacement procedures per 100 person-years.
Cox proportional hazards modeling showed that the cumulative dose of methotrexate or DMARDs resulted in a reduction in the risk for joint replacement by about 2%. A shorter time to joint replacement was seen in patients who used both methotrexate and another DMARD. The risk for joint replacement increased with the cumulative use of NSAIDs and COX-2 inhibitors, prior joint surgery and diagnosis with osteoarthritis at baseline. After 6 years of follow-up, the cumulative risk for joint replacement in patients who received early treatment with methotrexate or other DMARDs is 5% compared to 7% in patients who were not treated in the first year following diagnosis with RA. – by Shirley Pulawski
Disclosure: Moura reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.